MEDICARE: SUMMER SHULTZ JOHNKE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	101925	NY

General Provider Information

NPI Number	:	1548994510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER SHULTZ JOHNKE LCSW

Provider Business Mailing Address
First Line	:	232 TAAFFE PL APT 401A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4394
Country	:	US
Telephone Number	:	303-898-3569
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 TAAFFE PL APT 401A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4394
Country	:	US
Telephone Number	:	303-898-3569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	01/19/2026

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